Search for questions to ask a home care agency and you will find a hundred lists. They are almost all written by agencies, and they are almost all soft: are you licensed, are your caregivers insured, do you do background checks. Every agency answers yes to those, so they sort nobody.

Here is what families actually write on caregiver forums after six months with an agency:

Been there. Had people we loved but never had a single person who showed up on time consistently. Missed a lot of doctor appointments.

We had horrible, horrible problems with an agency. Sometimes my mom was even left alone, and she is totally immobile. They didn't even bother to call.

Notice what is not in those complaints. Nobody is upset about credentials. The failure is coverage. An aide calls out, nobody sends a replacement, nobody phones to say so, and a person who cannot get out of a chair is alone all day.

So ask about that. These are the questions we would want a family to ask us, and we have written them the way you should actually say them.

The four that matter most

1. What happens when the aide calls out at six in the morning?

This is the whole thing. Do not accept "we always find someone." Ask for the mechanics: who takes the call, how quickly do you know, who phones me, and by when. A good answer sounds like a process with times attached. A weak answer sounds like a promise.

2. If you cannot fill the shift, do you call me, and how soon?

Every agency misses a shift eventually. Staffing is hard and people get sick. The difference between a decent agency and a bad one is not whether it happens, it is whether you find out from them or from your mother at eleven o'clock. Get a commitment on notification and get it in writing.

3. How many different aides will my mother see in a month?

Ask for a number. Two or three is a care team. Eleven is a rota, and for anyone with dementia a rota is close to useless, because the relationship never forms and every visit starts from nothing. Ask specifically who covers weekends, since that is usually where consistency collapses first.

4. Who do I call at seven on a Sunday evening, and will a person answer?

Ask for the actual number and then test it before you sign anything. Call it on a Saturday. What happens is your answer.

On money and liability

5. Are your aides your employees, or are you a registry?

This is the single most consequential question on the list and most families never ask it. If the agency employs the aide, the agency carries payroll taxes, workers compensation, liability insurance and supervision. If it is a registry or referral service, you may be the employer, with all of that landing on you. If an aide hurts her back lifting your father, that distinction decides who pays.

6. If something goes missing, what is your process?

Families ask this online constantly, usually after the fact, and the answer they get is often that it is between them and the worker. Ask up front whether the agency is bonded, what happens on the first report, and whether an aide is pulled from the home while it is looked into. An agency that has thought about this will tell you its process without becoming defensive.

7. What is the minimum, and what is billed when we cancel?

Most agencies have a minimum shift length and many have a weekly minimum. Ask what happens when your mother is admitted to hospital for nine days. Ask what notice a cancellation needs. These clauses are where unexpected invoices come from.

8. What costs more than the base rate?

Overnight, weekends, holidays, mileage, transportation, two person assists. Ask for the list rather than the headline number.

9. How do I end this, and how much notice?

Ask before you start, when everyone is being pleasant. If the answer is uncomfortable now, imagine it in month seven.

On the actual work

10. Can your aides do stairs, and will they?

Can and will are different questions. Many agencies prohibit it on liability grounds, which is a defensible policy, but you need to know before the day your father cannot manage the staircase. Same for transferring someone who cannot bear weight, and for whether they will drive your parent in their own car or in yours.

11. If she refuses the shower, what does your aide do?

The best diagnostic question on this list, especially for dementia. A weak agency says the aide will encourage her. A good one describes technique: coming back later, changing who asks, a bed bath instead, warming the room first, breaking it into parts across two visits. Ask what training the aides have specifically in dementia care, and listen for whether the answer is a certificate or a method.

12. What if my mother does not want anyone in the house?

Very common and rarely discussed. Ask how they staff a hostile first visit, whether the first aide is chosen for that, and whether a shorter first visit is an option. An agency that has done this a hundred times will have opinions. One that has not will be surprised by the question.

13. How will I know what happened today?

If you live an hour away or three states away, this decides whether you sleep. Ask what gets logged, whether you can see it, and who calls you if something changes. Ask what would prompt a call rather than a note.

14. Who supervises the aide, and how often do they visit?

An aide who is never observed is an aide nobody is helping either. Ask whether a supervisor comes to the home, how often, and whether the care plan gets revisited as things change.

Get four things in writing

A pleasant conversation with a coordinator is not a contract, and the coordinator may not be there in a year.

• The callout and coverage policy, including when they notify you.
• The full rate card, with every surcharge.
• Cancellation terms and any minimum.
• What the aide is and is not permitted to do, stairs and transfers named specifically.

Two warning signs

An agency that answers yes to everything. Every real agency has limits. If nobody names one, either they have not thought about it or they are telling you what you want to hear, and you will find the limit yourself later at a worse moment.

Pressure to sign today. There is no version of this where a good decision has to be made in one phone call.

If you are already with an agency that is failing

The forum post that stayed with us was from someone who said they would fire the agency if it were not for two caregivers who were genuinely good with their parents. That is a real trap, and it is worth naming.

Before you move, write down two weeks of what actually happened: dates, times, who came, who did not, who called. Take it to the agency's manager rather than the scheduler, because schedulers cannot fix systemic problems. A written record changes that conversation completely. If nothing improves, you have your documentation, and if you do switch, ask the new agency whether aides you trust can be requested by name. Sometimes they can, since aides move between agencies more than families realize.

And in Massachusetts, call MassOptions at 1-800-243-4636 and ask for your regional ASAP. The assessment is free, and an ASAP care manager has seen every agency in your area and has no commercial interest in which one you pick.

Ask us the same questions

Every one of them. If we cannot answer a question on this page clearly, that tells you something, and you should go elsewhere.

Care Remedy provides home health aide care, wheelchair transportation and stair assistance across eastern and central Massachusetts, from offices in Woburn, Springfield and Brockton. Call 781-957-8076.

Quoted comments above are from public caregiver forums and are reproduced as posted. Employment, bonding and insurance arrangements vary by agency and by state; ask any provider directly rather than assuming. MassOptions and ASAP details are from Mass.gov. This is general information and not legal advice.